Filarial Chylous Ascites With Chylothorax: Successfully Treated With Diethylcarbamazine, Doxycycline and Octreotide

摘要

Lymphatic filariasis is a common disease in the tropical and sub-tropical areas of the world. Lymphatic obstruction and the associated complications caused by the adult worms is an important cause of morbidity and cosmetic disfigurement. Most of these patients require shunt surgery to divert lymph flow. We report a patient who came to us with chylous ascites with chylothorax secondary to lymphatic filariasis. Surgical treatment was deferred in view of very poor nutritional status. This patient was successfully managed with Diethylcarbamazine, Doxycycline and Octreotide without any surgical intervention thereby highlighting the need for an aggressive medical management of patients who are unlikely to tolerate surgery. Case report A 22 year old female, resident of Mumbai, India, was referred to us with abdominal distension and breathlessness at rest since 14 days and intermittent fever with dry cough since 10 days. On examination, patient was febrile, cachexic with normal pulse and blood pressure. There was no neck vein distension. She had firm, discrete inguinal lymphadenopathy and pitting bipedal oedema. Her breath sounds were not audible in the right mid and lower zones. She had a tense ascites. Her hemoglobin level was 11.5 gm%, WBC count-8600/cumm with polymorphs-74%, eosinophils-13%, lymphocytes-13 %, adequate platelets. Her X-ray chest showed a massive right sided pleural effusion. Liver function tests, serum creatinine and electrolytes were normal. Urine examination was normal. Ultrasound of the abdomen showed massive ascites with normal liver and spleen. The ascitic fluid was milky in appearance (Figure 1) with proteins-6.3 gm%, 90 leucocytes with lymphocytes-86%, polymorphs-14% and no acid fast bacilli, other organisms or malignant cells. The pleural fluid was also milky and showed proteins-7.9 gm%, sugar-119 mg/dl, 80 leucocytes with 90% lymphocytes and 10% polymorphs with fair number of red blood cells in both.